AUGUSTA — In a long-simmering and politically charged dispute, the Family Planning Association of Maine has asked a judge to overturn a Department of Health and Human Services order seeking repayment of $184,000 the state says it overpaid the nonprofit group from 2006 to 2010 in connection with reproductive health-care services provided to women on the same day that they had an abortion.
The charges were for Depo-Provera — a birth control shot — bills above acquisition costs, and for services that lacked documentation.
The association’s court appeal, filed in Kennebec County Superior Court at the Capital Judicial Center, states that prior to the LePage administration, the Department of Health and Human Services “consistently interpreted MaineCare rules to cover reimbursement for clinically necessary reproductive healthcare services provided to pregnant women regardless whether those women subsequently had abortions.”
DHHS spokesman David Sorensen said Wednesday that the department conducted an audit that revealed Maine Family Planning “had been improperly billing Maine’s taxpayer-funded Medicaid program for abortion-related services in violation of Medicaid law.” Sorensen said it was “a clear violation” for the association to bill “taxpayers for abortion-related services provided on the same day as abortions.”
“The department has taken appropriate action to enforce the law, treating Maine Family Planning’s case as it would any other audit of a MaineCare provider,” Sorensen said.
Kathleen Brogan, vice president for public affairs at Maine Family Planning, on Wednesday called the matter “an internal Medicaid billing dispute.” The total amount sought by DHHS is $184,620.
“We got some direction from the department more than 10 years ago for what services would be reimbursable, and they said we were not allowed to bill them that way anymore,” Brogan said. “They just changed their interpretation of what was appropriate and never let us know. We think it’s very interesting that we billed that way through two administrations, and very soon after the current administration took over, it became unacceptable.”
Brogan also said the association quit billing for those services as soon as it became an issue.
The court appeal alleges that before any findings were reached in the audit of MaineCare billing, DHHS “asserted to Republican legislators with anti-abortion views” that the Family Planning Association had committed fraud.
The association has been working with the state department to try to resolve the dispute, Brogan said. If its decision stands, the agency will pay and “it will be a burden, but it’s not going to stop us from providing services.”
The association’s appeal was written by attorneys Taylor Farns and Benjamin Townsend. Jennifer Thibodeau, director of communications and marketing for Maine Family Planning, sent a prepared statement by George Hill, CEO of Maine Family Planning, saying “we believe our case has merit and that we will find in the Superior Court setting a more objective, more impartial setting in which to state our case.
“For over 44 years, Maine Family Planning has maintained the highest level of fiscal and professional responsibility, working with federal, state and private funders to provide affordable family planning services to tens of thousands of Maine people. Maine Family Planning has responsibly managed hundreds of millions of dollars of public and private funds, has participated in regular audits and fiscal oversight, and until now, has never been accused of any impropriety or mismanagement.”
Hill’s statement says the appeal was undertaken at the behest of the agency’s board of directors and noted that the agency has been subjected to the state department’s investigation for the past five years.
In a news release Wednesday, DHHS Commissioner Mary Mayhew said audits of Medicaid providers “are a key component of that work and required under the federal Medicaid program.”
“Federal law prohibits taxpayer-funded Medicaid reimbursements for abortion services, with limited exceptions,” Mayhew said in the release. “Maine Medicaid regulations prohibit reimbursement for any services ancillary to a non-covered service. The audit of Maine Family Planning found that they had billed Medicaid for ancillary services, including abortion-related services provided on the same day as an abortion.” The department requested that Maine Family Planning repay the amount paid for those prohibited billings, she said.
Documents included with the association’s appeal show that a notice of violation was sent to Maine Family Planning’s Augusta post office address on June 24, 2011. That followed a review of billing practices limited to MaineCare members who had ultrasounds billed with other services. Initially, documentation for 10 members had been requested in November 2010, and that was expanded to requests for documentation for 100 randomly selected members in March 2011.
A recommended decision by administrative hearing officer Richard W. Thackery Jr. was issued Aug. 11, 2015, following an earlier appeal by Maine Family Planning. Thackery’s was adopted as a final decision on Sept. 3, 2015, by Mayhew. The court appeal is in response to that.
Thackery’s decision includes recommended findings of fact, which say that Family Planning Association of Maine provides family planning services at 18 sites in Maine and began providing abortions in April 1997 at the Gabriel Drive site in Augusta.
Maine Family Planning is a member of the National Family Planning & Reproductive Health Association. The national membership group takes in federally funded family planning organizations, including Planned Parenthood and Family Planning Councils, serving low-income men and women and minors, according to its website.
The court appeal quotes sections of the MaineCare benefits manual that say “MaineCare covers abortions ‘only if necessary to save the life of the mother, or if the pregnancy is the result of an act of rape or incest.'” In a message distributed widely to medical care providers, DHHS also said, “If the abortion will not be covered by MaineCare, then any related services both prior to and following the abortion are also not covered. This includes blood tests, ultrasounds, or other tests. Before the procedure, the provider needs to tell the member that she will be sent a bill for the services.”
Betty Adams — 621-5631
Twitter: @betadams
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